Tualatin physician discusses symptoms, risks — and why prevention is the best cure

by: LEGACY MERIDIAN - Each year, the flu differs in severity and target demographic. Although children ages 4 and younger and adults 65 and older are generally considered the most vulnerable populations, this years pH1N1 virus, a strain of Influenza A, is disproportionately impacting young and middle-aged adults, according to the U.S. Centers for Disease Control.Oregon authorities are urging people to get the flu vaccine as hospitalizations increase. A 5-year-old died from the disease after falling ill Christmas Day and a 52-year-old Salem woman died Jan. 7 from complications from the flu.

According to the Oregon Health Authority, there were 81 flu-related hospitalizations during the week of Christmas, with many of the cases involving the H1N1 strain. So far in Portland, at least seven people have died from the flu this season, according to KOIN 6 News.

The flu is tracked locally in two main ways. First, hospitals within the Portland area report when patients are admitted and have a laboratory confirmed case.

Second, a network of 25 clinics around the state reports the percentage of patients with flu-like symptoms. If that number is less than 1 percent, it’s usually just colds and other viruses. When it’s more than 1 percent, flu season has started. That number recently hit 4 percent. This flu season is expected to last another six to eight weeks.

Flu season began Nov. 26, 2013, according to Legacy Meridian Park Medical Center.

That’s when the first of 329 people visited the hospital with concerns they were suffering from this year’s brand of the H1N1 virus.

Fifty-eight of them were, although the majority of flu cases don’t merit a visit to the doctor.

As visits continued to rise, Legacy implemented visitor restrictions on Jan. 9, limiting no more than two visitors per patient and hospital visitors ages 18 and younger were being limited to immediate family members only.

In Wilsonville, health care providers said they have not seen a marked increase in flu cases over a typical year.

“I wouldn’t say necessarily that we’re seeing a lot of flu cases,” said Justin J., a health team associate for Zoom Care, an on-demand health care provider that operates a chain of clinics throughout the Pacific Northwest, including in north Wilsonville.

“I schedule all the patients for all clinics in the Northwest,” said Justin, who declined to give his last name. “I’m part of a team of seven or eight of us that are here today, and we touch every single patient, so I get a pretty good idea of what we’re seeing.”

Instead, pneumonia and bronchitis have been more prevalent to date, he said.

“There definitely are patients coming with flu, but not as many; people are being pretty cautious about it,” he said.

At the Wilsonville Senior Center, Senior Programs Manager Patty Brescia said she has not heard of a significant uptick in flu cases among local residents.

“We haven’t seen anything out of the ordinary, other than the occasional person,” Brescia said. “We used to offer flu shots at a clinic we held, but now they’re so readily available everywhere that it’s been easier for people to go to their own doctor or go to Walgreen’s to get it.”

“Schools are a reflection of the community at large and so reflect illness rates and health concerns,” Paula Hall, West Linn-Wilsonville School District nurse, said. With students and staff in their first week back to school after the winter break, she was not able to provide data about illness rates.

“Our focus is on prevention,” Hall said. The district’s nursing staff sent flu prevention information, provided by Oregon Department of Health, to all schools and requested that the information be included in schools’ newsletters to parents.

HarperSean Harper, a physician with the Legacy Medical Group-Tualatin, explained that healthy people struck down by the flu simply need to ride it out. But infants and young children, some elderly sufferers, and certain groups are more at risk, including those with lung disease, asthma, heart disease and other chronic illnesses.

If you are not in one of those high-risk groups, do not suffer a persistently high fever, do not have trouble breathing and do not appear to be suffering an aggressive form of the illness, Harper said, unfortunately, you’ve just got to ride it out.

But there are two definite signs you should seek immediate attention: if you have trouble breathing or if you have a persistently high fever.

It’s a popular misconception that the flu must always be accompanied by a stomach illness and symptoms like vomiting or diarrhea, Harper said.

“It’s actually a respiratory illness, and it affects sinuses, the nose,” he said, adding that body aches, fevers, chills, a sore throat, cough and headaches are some of the usual suspects that can point to the flu.

Each year, the flu differs in severity and target demographic. Although children ages 4 and younger and adults 65 and older are generally considered the most vulnerable populations, this year’s pH1N1 virus, a strain of Influenza A, is disproportionately impacting young and middle-aged adults, according to the U.S. Centers for Disease Control.

“It’s hitting people in the area pretty hard,” Harper said.

Particularly severe cases of the flu can be treated in a clinic setting, according to Harper, but widespread use of antiviral medications is risky, as viruses can become resistant and increasingly difficult to treat.

“We try to minimize the amount of overtreatment,” Harper said. “We don’t have a whole lot of medications (for the flu), and we want the ones we do have to work.”

Prevention is key. Two-thirds of the patients admitted to Legacy Meridian Park for flu treatment had not received their seasonal flu vaccines.

“You can get a flu shot and still get sick from the flu, but if you’re not immunized, you tend to have harsher symptoms,” Harper said. “It’s like if you wear a seatbelt, you’re less likely to get injured in a car accident.”

The CDC recommends everyone 6 months of age and older get a flu vaccine, with rare exceptions.

Zoom Care is scheduling 50 or so flu shots a day right now in Wilsonville, which means word is spreading about the severity of the present flu season.

“We have certain clinics in the Portland, Salem and Vancouver areas that are administering flu shots for what we have left in inventory,” the Zoom Care associate said. “It’s diminishing very quickly at this point, and for pediatric patients we’re just about out. I’d expect we’ll be completely out by next week, it’s really going fast.”

Brescia also stressed the importance for seniors of being vaccinated against both pneumonia and shingles, which hit the elderly population disproportionately harder.

“It’s a big risk for seniors,” she said. “It’s an important piece for people to learn.”

The Oregon Perinatal Collaborative is also urging every pregnant woman to get a flu shot. Health complications resulting from influenza infection, such as pneumonia, can be serious and even deadly.

“Pregnant women and their newborn infants are at increased risk for serious complications from the flu, particularly from the strain that is currently out there,” said Mark Tomlinson, M.D., member of the OPC and regional medical director for obstetrics, Oregon region, for Providence Health and Services.

Newborns whose mothers receive the flu shot during pregnancy can be protected for up to six months until they begin receiving their own flu vaccinations. The CDC recommends that everyone six months or older, including pregnant women, should be vaccinated against the influenza virus.

Even those who claim robust health and little to no history of getting sick should get the flu shot, Harper said, in the interest of herd immunity.

“If we immunize everyone in the herd, then the weak people in the herd have greater protection,” he said. “The chance of that newborn getting sick is less, because there’s less of a chance of the flu coming into that house.”

The flu vaccine changes each year, but typically guards against three strains of the flu determined most likely to hit that year. Because the vaccine addresses only a fraction of flu strains circulating, it is possible to still get sick, or to get sick more than once in a season.

“If patients have influenza, I tell them, ‘As soon as you start feeling better, let’s bring you in and get that shot,’” Harper said.

— Josh Kulla, Kate Hoots and Koin Local 6 contributed to this story.

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